Spirometry in Occupational Health—2020

Abstract

This document addresses aspects of the performance and interpretation of spirometry that are particularly important in the workplace, where inhalation exposures can affect lung function and cause or exacerbate lung diseases, such as asthma, chronic obstructive pulmonary disease, or fibrosis. Methods: Issues that previous American Thoracic Society spirometry statements did not adequately address with respect to the workplace were identified for systematic review. Medline 1950-2012 and Embase 1980-2012 were searched for evidence related to the following: training for spirometry technicians; testing posture; appropriate reference values to use for Asians in North America; and interpretative strategies for analyzing longitudinal change in lung function. The evidence was reviewed and technical recommendations were developed. Results: Spirometry performed in the work setting should be part of a comprehensive workplace respiratory health program. Effective technician training and feedback can improve the quality of spirometry testing. Posture-related changes in FEV 1 and FVC, although small, may impact interpretation, so testing posture should be kept consistent and documented on repeat testing. Until North American Asian-specific equations are developed, applying a correction factor of 0.88 to white reference values is considered reasonable when testing Asian American individuals in North America. Current spirometry should be compared with previous tests. Excessive loss in FEV 1 over time should be evaluated using either a percentage decline (15% plus loss expected due to aging) or one of the other approaches discussed, taking into consideration testing variability, worker exposures, symptoms, and other clinical information. Conclusions: Important aspects of workplace spirometry are discussed and recommendations are provided for the performance and interpretation of workplace spirometry.

Validation of the Global Lung Function Initiative 2012 Spirometry Reference Values in a Healthy Italian Working Population

“…Spirometric tests were obtained from a single spirometer (a portable “Spirolab III” turbine flowmeter, MIR, Rome, Italy) used at the “Federico II” University Hospital of Naples (Italy) during the execution of health surveillance medical examinations. A factory-calibrated reusable turbine flowmeter was used, the turbine’s blades were regularly cleaned, and a daily calibration of the instrument, that has been tested to meet the ATS/ERS recommendations for occupational testing [ 1 ], was performed using a special pre-calibrated and certified 3 L syringe (0.5 L/s injection over 6 s) (MIR, Rome, Italy). All spirometric tests were performed according to the ATS/ERS 2019 criteria [ 18 ].…”

“…Spirometry is the main pulmonary function test (PFT) used to assess lung function and for this reason, in the field of Occupational Medicine (OM), it is fundamental for the diagnosis and prevention of occupational lung diseases [ 1 ]. In detail, simple spirometry, through the study of dynamic lung parameters and the forced expiratory maneuver, represents a key tool in the context of workers’ health surveillance to early identify ventilatory deficits that could influence the fitness for work-related to a specific job.…”

Physiology and Biomarkers for Surveillance of Occupational Lung Disease

“…3 19 This has been acknowledged for many years and was well known at the time of the initial surveys on coal workers' pneumoconiosis 19 Spirometry is only one component of a screening program and needs to be interpreted in conjunction with other tests. 15 16 17…”

Assessment of Pulmonary Function Test among Employees of Petrol Filling Stations

“…Spirometry, the most frequently performed pulmonary function test (PFT), is the cornerstone of occupational respiratory evaluation programs. In the occupational health setting, spirometry plays a critical role in the primary, secondary, and tertiary prevention of workplacerelated lung disease 7 .…”

“…In occupational health field, spirometry is still widely used to screen workers for their ability to perform certain tasks or efforts, and to evaluate workers' respiratory health in medical surveillance programs. Therefore, spirometry results can play a central role after hiring, in decisions about worker job assignments, in use, choice and efficacy assessment of personal protective equipment (PPE), and also in the assessment of exposure-related health effects 7 .…”